“We Create Community Through People. Parks and Programs”
Come out and be a part of the Central Coast’s premier
track meet. Open to Boys and Girls 3rd thru 8th grade.
Awards given to top 6 places. Events include: Sprints
and distance runs plus field events.
Check in: 8:00-8:45AM
Time: 9:00AM-5:00PM
Location: Lompoc HS Track
Fees: $10.00 per athlete.
$150 per club or school team
(25 athletes max per $150)
Register by: April 14th
For more information, please call the Lompoc Recreation Division at (805) 875-8100
or register at 125 West Walnut
Avenue.
Check us Division
out on Facebook and online at
Lompoc
Recreation
www.cityoflompoc.com
Kiwanis
Track and Field Championships 2017
Registration Form
Participant:_______________________________________________________________________________________
Grade:______________ Age: ______________
Date of Birth: _____________________________________________
Address:____________________________________________ City________________________ ZIP_______________
Day Phone:_______________________________
Evening Phone: _____________________________
School / Club Attending:_____________________________________________
Gender:
3rd/4th Grade
5th/6th Grade
7th/8th Grade
50 yard dash
100 yard dash
220 yard dash
440 yard dash
880 yard dash
Softball Throw
High Jump
Long Jump
Mile Run
440 Relay(G)
440 Relay(B)
Mile Relay(G)
Mile Relay(B)
100 yard dash
220 yard dash
440 yard dash
880 yard dash
Long Jump
Shot Put
High Jump
Mile Run
440 Relay(G)
440 Relay(B)
Mile Relay(G)
Mile Relay(B)
100 yard dash
220 yard dash
440 yard dash
880 yard dash
Long Jump
Shot Put
High Jump
Mile Run
2 Mile Run
440 Relay(G)
440 Relay(B)
Mile Relay(G)
Mile Relay(B)
Male
Female
Please circle the events you wish to participate
(Maximum of 4 events, including the relays)
The undersigned hereby agrees to defend, indemnify and hold harmless the City of Lompoc and its officers, employees, and
agents from and against all loss, liability, charges and expenses (including attorneys fee) and causes of whatsoever character
which may arise by reason of participating in the 2017 Lompoc Recreation Division Youth Track and Field Meet or be
connected in anyway therewith. The City of Lompoc does not provide accident, medical, liability, workers compensation
insurance or other insurance for program participants.
___________________________________________________________
Signature of Parent or Guardian
________________________________
Date
For more information contact: Chad Dawson/ Recreation Supervisor at 875-8092.
125 West Walnut Avenue, Lompoc, Ca 93436